1. Business/Technical Scope Questions
Page Section
Q# Question / Clarification Answer
# #
Generic/Common
1. 2 Will the Government of As displayed on the gov.bm website, the
Bermuda Department of Social dates have been extended to reflect the
Insurance extend the response issues encountered with the website to
due date by 30 days in order submit questions as well as the delay in
for vendors to prepare a responding to the questions. The new
thorough response? response date is July 30, 2007.
2. 15 Will DOSI allow questions after Questions have been allowed beyond the
June 15? original June 15 deadline.
3. Is IBM, mentioned as the Yes.
author of the RFP
requirements, precluded from
bidding on this solicitation?
4. 4 What is the technology now Technology is only used for premium
supporting premium administration for individual HIP policies
administration? – the technology is an in-house
developed RPG application running on
AS/400.
5. 4 Many of the business goals of The main goal with this RFP is that of
HIP are what could be claims automation, so if you think a BI
considered part of a Business component is needed it should be
Intelligence solution for HIP. included as part of the response. The
 Would the Government of primary focus of the HIP RFP to improve
Bermuda Department of the processing of claims. DOSI is not
Social Insurance allow willing to consider a separate solicitation
vendors to submit bids on for BI at this time.
(1) only the BI component,
(2) only the claims
processing component, or
(3) both?
Alternatively, would DOSI be
willing to release a separate
solicitation for the BI
component?
6. 4.3.1 What is the “existing back Manual, with the exception of limited
office system”? policy administration functionality to
support premium billing for individual HIP
policyholders.
7. The requirements document Yes, however if it can be integrated as
has all the requirements for part of less costly solution that is
administering insurance acceptable too.
policies, including premium
collection. This implies the
current HIP individual policy
system will be replaced by the
new system. Is this the case?
32bbb6ca-3e29-4a00-8077-0886c0f60e45.doc
Page Section
Q# Question / Clarification Answer
# #
8. If the current HIP individual Yes.
policy system is to be replaced
should the proposal include
conversion of the data?
9. 4.3.4 The RFP references the See “General Information” on the
Government of Bermuda's Information Technology Office web site
Standard Development for more details of the standard
Agreement and a Statement of development contract and Statement of
Work. Work) .
 Are there any other or
more specific terms and
conditions?
Has the actual Development
Agreement for this RFP been The standard agreement will be used.
written yet, and is it available
for review?
10. 4.3.8 What is the “single page on The spreadsheet is available on the
the Microsoft Excel Government websites RFP section under
spreadsheet” and where do we the heading “Related Documents” for this
get it? RFP.
11. 5 On page 8 of the requirements Claim volumes at this time are very
document it specifies that the difficult to determine due to the manual
HIP section processes 135,000 processes. It is felt that the claim
claims annually. Then in the volumes are in the range of 90,000 to
breakdown it has HIP – 135,000 which would be prorated
222,000, MRF - 3,500, Subsidy accordingly for the stated claims.
- 65,000, War Veterans – 500.
This is 91,000. I am guessing
the 135,000 is perhaps a
newer statistic but the
breakdown is only older
statistics. Is this correct? Is
so, can I assume the
proportions are ballpark the
same? If not, what are the
other 44,000 claims for.
12. What is the membership Yes.
breakdown of the different
lines of
business i.e. is there any
membership overlap between
the different
plans - do members belong to
the HIP and the MFR?
Response to Vendor Questions on HIP Automaton Project RFP 2 of 27
Page Section
Q# Question / Clarification Answer
# #
13. 13.4 This section suggests that this Fixed price, and payments based on
is a fixed price contract. milestones and deliverables associated
 Is that correct and will a with those milestones.
single purchase order be
issued for the entire
contract amount?
Will payments be based on
acceptance of milestones?
14. Can you provide samples of Samples will be provided after the
claims forms, reports, etc. that contract is awarded.
are currently being used by
DOSI?
15. Is the customer okay Any solution will be considered and
evaluating a Buy (buy existing evaluated.
COTS product and do the
required customization) Vs
Build Option (Build a home
grown application)?
16. Have any off-the-shelf or Any solution will be considered and
customized proprietary evaluated.
solutions been evaluated? Is
the vendor expected or
allowed to provide such a
solution?
17. Is there a budget that the A high level budget has been established.
customer has earmarked for
the project and if so, is the
customer willing to disclose the
same?
18. Are the timelines very rigid or There is some degree of flexibility on the
is the customer open to a schedule and it is assumed that the
flexible implementation implementation will be a phased
schedule based on the approach.
customer prioritization of
requirements?
19. Users of the application – Are The users are located in Bermuda but
they going to be located across there will be times when the users of the
the globe/country etc or are system will require access globally.
they going to be located at the
single place?
20. How is IBM involved in the HIP IBM assisted with the approach to
Automation application and its requirements gathering. As HIP moves
development? their automation project, they will
continue to evaluate what assistance they
may require from outside consultants.
Response to Vendor Questions on HIP Automaton Project RFP 3 of 27
Page Section
Q# Question / Clarification Answer
# #
21. 4 RFP mentions “Group Policy It is expected that the vendor will
Holders are not supported by suggest an efficient approach to
technology. All the other converting the paper based system to the
processes are manually proposed automated solution.
supported by paper & excel
spreadsheets” - we would want
to understand more clearly
with respect to moving the
data in the paper based
systems to the new HIP
Automated System.
22. 6.1 There is a specific requirement HIP‟s strategy is to accept claims
to submit paper claims, how electronically when possible. HIP must
we‟d achieve a completely always be able to accept paper as one of
paperless claims processing in the input types, but after claims receipt
that scenario? the process should be paperless.
23. 6.2 Table 1: Scope of the HIP Yes.
Automation Project
Not all the functions marked in
the green in the BCM have
been covered in the detailed
requirements. The vendor will
estimate for the functions for
which the requirements have
been provided.
24. 6.2 Non-Functional requirements – The response is expected to propose a
It is our understanding that in complete solution and the
the proposal we only will implementation of it.
provide the estimates for doing
the analysis and not the actual
server capacity and size
required for the new
application. Is this correct?
25. 6.2 In case of mismatches Follow the spreadsheet.
between the requirements in
the spreadsheet and section
6.2 Scope of HIP Automation
Project – which one should we
follow between the two?
26. 7.1.1 Does HCS require vendor to Ultimately, HIP is looking to satisfy all
include the items marked as requirements. The primary focus of the
“Medium”/”Low” in it‟s scope vendors should be on the high
since the implementation requirements, however, HIP is interested
timeline is >2 years for those in how the vendors may be able to satisfy
requirements, whereas HCS is all of their requirements.
looking at going live by June
2008? Please confirm?
Response to Vendor Questions on HIP Automaton Project RFP 4 of 27
Page Section
Q# Question / Clarification Answer
# #
27. 8.2.5 What is the proposed Currently the deployment environment is
deployment environment? IBM iSeries, and Wintel. Databases are
Does the vendor have the IBM iSeries DB2 and Oracle.
choice to provide the
deployment environment (eg
IBM iSeries 2 or Oracle)?
28. 8.2.5 What are the versions of the Assume current versions of the software
hardware/software proposed? and hardware.
29. Are there any constraints in At this time there are no anticipated
offshoring part of the constraints.
application development and
delivery? In this context it
might be necessary to set-up a
communication and data link
with the Offshore Development
Center (ODC). Is DOSI ready
for this arrangement?
30. Will there be any data Data from the paper based systems and
migration or data conversion data contained in the individual premium
required to manage the admin system will need to be migrated to
existing data in whatever the new automated system.
format they exist?
31. Please specify any mandatory At this time within Bermuda there are no
compliance requirements apart mandatory compliance requirements. It
from HIPAA (eg. SOX or is HIP‟s intention to comply to the HIPPA
government mandated requirements where it makes sense.
compliance requirements).
32. Please explain your current All claims are submitted on a paper
claims submission process format.
33. Do you/private healthcare Some of the providers currently use these
providers use ICD-9, CPT-4, codes. It is the intent of DOSI to utilize
HCPCS codes, Drug codes etc standard codes such as ICD-9, CPT-4,
for billing healthcare services? HCPCS and drug codes for all providers.
34. Do you have documented rates The majority of the healthcare services
for each of the healthcare rendered have documented rates. The
services that are rendered by a procedures that tend to be rare have yet
service provider? to be developed. These are developed as
the claim presents itself.
35. Do you have contracts with Yes. Informal agreements exist, but we
healthcare service providers do not have a formalised contract other
(doctors and hospitals) for than legal regulations.
rendering different services?
36. Is the vendor permitted to use Yes, depending on type of software.
open source software other
that those mentioned in the
RFP?
37. Are there any batch processing The payment processing with JDE is
requirements for the HIP batched.
Automation? Or would this be
finalized at time of
requirements and design?
Response to Vendor Questions on HIP Automaton Project RFP 5 of 27
Page Section
Q# Question / Clarification Answer
# #
38. Does DOSI have any internal Java or Microsoft.net.
standards w.r.t. to different
components being developed
for the HIP Automation
application?
39. What is the underlying AS400 and RPG.
technology framework for
Premium Administration for
Individual policy holders?
40. 10 RFP In what form of documentation If the as-is processes are required, they
Section 4 will DOSI provide us with the can be provided via paper and electronic
detailed as-is business process such as Visio and Excel spreadsheets.
flows of the way health
insurance is administered
presently as a combination of
electronic, and manual - by
paper and excel spreadsheets?
41. Will DOSI want to have a Yes. It is anticipated that all key
consumer driven/consumer stakeholders such as customers,
empowerment aspect to this providers, etc will interface with the
system? Interfacing with system through the government portal –
different portal interfaces for WebSphere or through an independent
different stakeholders like site.
Members, Providers, Payer,
Sponsor, etc.?
42. Will DOSI want to include a What is PHR??
PHR element in the member
interface?
43. 29 8.1 The evaluation process refers The vendor may suggest either; however
to a demo of the vendor‟s a COTS is the preferred approach.
product offering. DOSI has seen demos using both AS400
 Is DOSI seeking only a and Microsoft as platforms.
“COTS” solution or is DPI
open to custom developed
solutions for the Business
Intelligence component?
Has the DOSI previously seen
or been demonstrated any
solutions in envisioning the HIP
application? If so, who were
the vendors?
44. 33 8.2.1.4 Accountability/Non- At a minimum any transaction resulting in
repudiation: On what kind of a payment should be non-reputable.
transactions do we need to Long term the government is anticipating
implement this security rolling out certificates across all
feature? Are we looking at departments.
digital certificates to be
associated with parties
involved in such transactions?
Response to Vendor Questions on HIP Automaton Project RFP 6 of 27
Page Section
Q# Question / Clarification Answer
# #
45. 34 Authentic The Session context may be stored on the
ation/Ide „Authentication/Identification‟ client as long as it is tamper proof.
ntification section says that the client
; must not be used for
Access maintaining session context
Control whereas the „Access Control‟
section says the client could be
used by the storage must be
tamper proof. Which
requirement should be treated
as correct?
46. 34 Authentic Our understanding is that The understanding is correct, and there is
ation/Ide multiple directory services no plans to consolidate the two.
ntification (Active directory for internal
users and Application specific
for external users) are
currently present. Is there a
need to consolidate this under
only LDAP solution by
migrating existing user
information in different
application? If so, who is
responsible for this effort
(vendor or Client)?
47. Is there a long term plan for It is the intent to continue to use JDE for
keeping the JDE Edwards financial (accounting) functionality. The
Accounting System? If so, are proposed solution should be able to
you looking to integrate the interface with JDE.
new claims system with the JD
Edwards Accounting System?
There are extensive accounting
questions on the RFP matrix
that would be very specific to
independent accounting
software functionality. The
current JD Edwards accounting
package you use contains
much if not all, of the required
functionality listed in the
matrix.
48. 35 Administr It is mentioned that the Primarily documents such as claims in
ation/Con application should be able to paper form or faxes.
figuration handle binary data. What are
the different sources of binary
data for this application?
Documents could be available
in binary format. Are there any
other sources/scenarios?
Response to Vendor Questions on HIP Automaton Project RFP 7 of 27
Page Section
Q# Question / Clarification Answer
# #
49. 36 8.2.1.5 It is mentioned that support In this RFP it is intended to mean
for multiple product release multiple version of the application, the
levels in the same cluster must benefit being the ability to do application
be present. Does it mean updates without service interruptions.
multiple versions of application
infrastructure products like
application servers or is it
multiple versions of the
developed application? What is
the benefit envisaged by the
availability of this support?
50. 37 8.2.1.4 We expect that there are going Single sign-on would be a great benefit.
multiple applications to serve
the functionality. Is single sign
on required in this case?
51. 38 8.2.3 It is mentioned that the These systems are current or anticipated
architecture needs to support government systems such as customs
additional disparate systems and immigration.
for future? Can you please
elaborate the nature and kind
of these disparate systems so
that we can ensure that the
architecture supports them?
52. 38 8.2.3 Supporting delivery channels: Currently no other channels are
As of the RFP requirement we anticipated, however openness for adding
understand that the channels additional channels as the need arises
to be supported currently are would be a benefit.
portal (web), telephone, and
fax and paper documents.
What are the other channels
envisaged (say SMS, email
etc.)? Please elaborate
53. 8.2.5 What is the target application Currently the government supports both
framework for the project? Is it J2EE and .NET, however it would be
J2EE or .NET? Is there a need preferable if the HIP solution used only
to support both one framework.
54. 42 9.4.1 Since transport modes like Yes, as an example the government is
telephone (IVR), fax, paper are currently looking at cross departmental
mentioned are we envisaging products within the document / content
specialized products in the management area. An RFP will be issued
areas of content management, at some point, however it is at very early
contact center solutions and stages and an internal project sponsor
document processing? has not yet been identified.
55. Delivery Please specify the criteria for Typical project management processes
Approac sign offs at every stage in the will be followed during the project
h staggered process of lifecycle. It is anticipated that formal
requirement gathering and signoffs will be required before the
software development project moves into the next phase of the
project or milestone.
Response to Vendor Questions on HIP Automaton Project RFP 8 of 27
Page Section
Q# Question / Clarification Answer
# #
56. Do the providers use standard Standard claim forms are used by
claim forms to submit claims to providers to submit their claims.
DOSI?
57. Do you use standard coding Standard claim codes are used for
systems for recording recording diagnosis and procedures.
diagnosis and procedures?
58. How often does DOSI receive Premiums are normally received monthly
premiums from employers and but other modes of premium such as
individuals? quarterly and annual are accepted.
59. In what form are the Cash, cheques, credit card, ETF.
premiums received? E.g.
cheques, electronic fund
transfers etc
60. Our understanding is that Yes.
current claims processing
function is manual. Is this
correct?
61. Does DOSI have contracts on a) In Bermuda, HIP uses the Bermuda
fixed charges for healthcare Hospitals Board rates to form the basis
services with external hospitals of how much they will reimburse most
and doctors? claims, other types of services such as
diagnostic imaging, cardiology, surgical
procedures and laboratory tests are set
by the Bermuda Health Council through
DOSI and are updated for April 1st for
each year. Additionally, the Bermuda
Health Council negotiates with private
physicians and laboratories the rates for
standard procedures on an annual basis.
b) Outside Bermuda, DOSI currently does
not fix charges with hospitals and
doctors, however in the future DOSI
hopes to negotiate such rates through a
third party.
62. Does DOSI have Yes.
documentation of the same?
63. Are there any private health Yes, the MRF and Subsidy claims are co-
insurance parties with which, ordinated with other health insurance
some of the healthcare claims companies.
need to be coordinated with?
64. Please walk us through your We have process maps documenting
current claims process right current manual processes for most claims
from submission to denial or types.
payment of a claim. However, we expect a new process
tailored to the successful solution.
65. Please explain your current Current claims appeals are handled
claims appeals process without a formal or standard process on
an ad hoc basis.
We expect a new process tailored to the
system.
Response to Vendor Questions on HIP Automaton Project RFP 9 of 27
Page Section
Q# Question / Clarification Answer
# #
66. Is development expected to be Development, if any, can be wherever
performed only at onshore the vendor wishes.
location?
67. Will DOSI want separate This is a possibility. However, the current
portals with individual design government portal can also be utilized as
elements suited to different a log-in for all stakeholders.
stakeholders?
68. Are there any standard formats No.
used for electronic transactions
i.e. 834, 837, that are used in
the US for electronic
transactions?
69. Is the certificate of entitlement No. Currently, this information is stored
always recorded in any one entirely manually on index files stored at
system? If so which system? DOSI‟s offices.
In the future, the vendor's proposed
solution should be able to capture this
information.
Business Development (a)
70. 7.1 Why is Product Portfolio This was an oversight when highlighting
Tracking Requirements the requirements on the component
included in the Functional business model. Product Portfolio
Business Requirements when it Tracking is within scope of the HIP
is not highlighted in green in Automation Project.
Table 1 as part of the scope of
the HIP Automation Project?
71. a.5 a.5.1.1 Are there existing systems to No, there are no systems to capture HIP
capture products information. products at the present time. Capturing
Does the scope of the HIP HIP products within the solution is within
automation include developing the scope of the HIP Automation Project.
screens to capture products
information?
72. a.5.1.1 Need clarification on what it DOSI is looking to analyze the
means for DOSI to analyze performance of its products such as
products. What data profitability, volumes, lapses, claim
elements/parameters/metrics trends, etc.
need to be considered?
73. a.5.1.2 What are factors for Factors to determine the cost to
determining cost? administer products would include
volumes, transaction types, numbers of
transactions by type, time to process, etc.
Response to Vendor Questions on HIP Automaton Project RFP 10 of 27
Page Section
Q# Question / Clarification Answer
# #
74. a.5.1.2 Ability to determine the cost to Factors to determine the cost to
administer products. HIGH administer products would include
Do you have a list of what is to volumes, transaction types, numbers of
be included in the cost of transactions by type, time to process, etc.
administering the products?
i.e. salaries, office space, All DOSI‟s administrative expenses are
stationary, etc. budgeted, recorded, amended and
Are all expenses entered in forecast in the JD Edwards system.
some form via the JDE system? However, the government pays 100% of
NB: This will require a pro rata the expenses and then obtains 50%
of any details that cross reimbursement of the expenses from HIP
products, for example and MRF. HIP and MRF have no
department manager‟s salary, automated accounting system and
office space, etc. expenses are solely recorded in excel
spreadsheets used to produce financial
statements. On HIP and MRF financials,
administrative expenses are recorded as
a single consolidated line item.
75. a.5.2 Maintain claim experience 2.1 specifies electronic receipt, 2.4 the
5.2.1 specifies ability to storing of the information for historical
electronically receive the purposes. The key purpose is to calculate
annual claims experience and annual fees.
is a high priority where as
5.2.4 specifies ability to
historically store the annual
claims experience and is rated
as medium.
What is meant by “receive” the
annual experience if this does
not include storing it?
76. a.5.2.1 Our product can receive claims Electronically.
electronically, however in what
format do you anticipated
receiving claim history?
77. a.5.2.1 Will this requirement be We would accept the successful vendor's
implemented as a single suggestion on the best approach to this.
interface for all insurers or is A single interface or custom interfaces
their any customization would be acceptable.
required for each health
insurer? In that case please There are four major health insurers and
specify the number of health five approved schemes that would
insurers DOSI is currently interface with DOSI.
working with relevance to the
scope of this RFP
Response to Vendor Questions on HIP Automaton Project RFP 11 of 27
Page Section
Q# Question / Clarification Answer
# #
78. a.5 a.5.2.1 Will this requirement be Same response as 77 (above).
implemented as a single
interface for all insurers or is
their any customization
required for each health
insurer? In that case please
specify the number of health
insurers DOSI is currently
working with relevance to the
scope of this RFP
79. a.5.2.2 Does the scope include Scope includes automating all the
automating HIP alone or HIP, programs mentioned because they are all
MRF, Gov Subsidy & War under DOSI‟s operational control and
Veteran program as well responsibility.
80. a.5.2.2 Our product can receive claims Electronically.
electronically, however in what
format do you anticipated
receiving claim history?
81. a.5.2.4 Historical data storage – how This has not been determined yet.
long can the historical data can (However our manual data on file can be
date back to? (Example Data traced back to1970.) Currently there are
for past 3 yrs, 5 yrs etc) no plans to delete data.
82. a.8.1.17 By this we assume multiple Yes.
environments will be
maintained to support QA
before production roll out.
Correct?
83. a.8 a.8 Do we need to implement Yes, multiple versions of a product must
versioning capability of the be supported, including effective dates.
product? i.e., do we need to
system to store snapshots of a
product before any changes
are made to it?
84. a.8.1.1 Please clarify what is to be All forms of data will need to be stored
stored & maintained? Word including the actual legislation and the
documents? Spreadsheets? data/rate schedules along with the dates
Images? Text from the and corresponding CPT codes. These
legislation? Just the actual could be in Word, spreadsheets or .PDF
data/rate schedules along with files.
dates and corresponding CPT
codes?
85. a.8.1.1.5 Does this mean that you would Yes.
like to roll premium amounts
into one bill, then separate as
a line item when posting to an
account?
86. a.8.1.16 What is a policy reserve? Funds put aside to pay claims.
Response to Vendor Questions on HIP Automaton Project RFP 12 of 27
Page Section
Q# Question / Clarification Answer
# #
87. a.8.2.1 Is Post Implementation Will be decided based on the
support (like help desk) implementation. For the bid use training
expected? If so, for how long? for the HIP staff and general support for
six months. You may price optional
support if you feel that is necessary.
88. a.8.2.2 Not sure if this is an There is an expectation that this
expectation of the product to requirement will be satisfied, for example
be developed correspondence being loaded in the
system and generated at that next billing
cycle to inform stakeholders of product
changes.
89. a.8.2.4 Please clarify what product The production operational procedures
operational procedures are are all those procedures required to
referred to here. support the product such as new
business acquisition, policy
administration, claims, etc.
90. a.5.1.1 Are there existing systems to There are no existing systems
capture product information. whatsoever, except the policyholder
Does the scope of the HIP database for HIP only in the form of the
automation include developing AS400 system.
screens to capture product
information?
Policy Administration (b)
91. b.9.1.1 Requires clarification. Is the Yes, the government is considering
Government considering unique IDs – the length and format has
issuing unique ID‟s? If so, not yet been decided on.
what length and format?
92. b.9.1.2 How will an uninsured person Most of the residents of Bermuda are
acquire a user name and eligible for one of the HIP products.
password? Will they have to Persons claiming under a HIP product will
have a user name/password? be able to acquire a user name and
Would they not be able to password. They will not be required to
apply for insurance without a have a user name / password – it is an
user name/password? optional service to the residents. Yes,
residents would be able to apply for
insurance without a user name.
93. b.9.1.5 What approved schemes? Requirement b.9.1.5 seeks to allow DOSI
Sounds like a staff training to enter details of other insurers‟ policies
issue in our system. This would enable DOSI
customer representatives to quickly look-
up benefits offered by other insurers
when asked by members of the public
and advise the customers accordingly.
(DOSI receives the contracts/policy
wordings of all insurers on an annual
basis through the Re-licensing process.)
For example, a useful system feature
would be a screen or series of screens
providing a quick way to enter and
update other insurers‟ terms and
conditions.
Response to Vendor Questions on HIP Automaton Project RFP 13 of 27
Page Section
Q# Question / Clarification Answer
# #
94. b.9.2.7 Please elaborate on the scope Managing applications during the open
of this requirement. What enrolment period refers to being able to
activities would be included as capture the receipt of the application, the
part of “managing” status of the application, ability to
applications? identify where the application is in the
process, the outstanding requirements,
etc.
95. b.9.2.9 Would the medical declarations Yes, storing scanned images.
be stored in the System? If so,
are we looking at storing
scanned images? Please
confirm?
96. b.9.2.1 Will web, call centre and paper Yes, the process should be channel
application process flows be independent.
integrated with the system in
order to acquire applications,
queries and claims?
97. b.9.2.1 “Acquire customer via web, call Yes, the same web based screens should
centre, paper” - Our be used by all users..
understanding is that we need
to provide web based screens
to acquire customers. The
same web based screens
will also be used by DOSI staff
to acquire customers by way of
call centre and paper
applications. Please confirm
98. b.9.2.11 When a member records their Our current manual process involves
replies for the last doctor visit DOSI staff calling the doctor and the
details - what is the way to hospital to confirm the accuracy of the
validate the veritability of this statement. Outside of this, we have no
reply? way of verifying these statements are
accurate. However, if it is discovered
later that the member has incurred
treatment prior to the policy effective
date, the claim would be denied.
99. b.9.2.13 It is mentioned that “there is It is anticipated the underwriting process
minimal to no underwriting will be enhanced as a result of the new
done today” . Will the application and re-engineering the
proposed system have the processes.
same or will refine the existing
underwriting logic.
100. B.9.2.15 Ability to calculate HIP Flat rate with some adjustments based on
premiums based on age and age and residency status.
other criteria. What other
criteria is used to calculate
premium rates?
Response to Vendor Questions on HIP Automaton Project RFP 14 of 27
Page Section
Q# Question / Clarification Answer
# #
101. b.9.4.1 As per the requirement: Indicative of the total data.
“Ability to service upto 100.000
Bermuda residents “
Is this indicative of the total
data or are there any other
NFR implied in it?
102. b.9.4.10 Does it need to be an Should be automated and triggered by
automated process? If so, the customer reaching the specified
should it be online triggered or period of time for the residency
as a batch process. requirement.
103. b.9.4.9 Does it need to be an See response to question b.9.4.10.
automated process? If so,
should it be online triggered or
as a batch process.
104. b.9.1.3 Will incoming data be in Incoming data will be in specified formats
specified file formats. Are we and will be a combination of bulk data
looking at bulk data upload and individual updates.
here. Please confirm.
105. b.9.4.2 More clarity required. Please The ability to reinstate a policy once it
elaborate on the scope of has met the reinstatement requirements
activities which are part of this is needed. The date of the reinstatement
requirement. and each time the policy is reinstated is
required.
106. B.9.5.3 Ability to apply the bulk Yes.
premium to the policyholders
premiums. What does this
mean? Is the premium applied
to multiple entities (member
and employer group)?
107. b.9.5.10 Will the billing process be Event triggered – e.g. on the customer‟s
online or batch triggered. billing date, month end.
108. b.9.5.12 No. of Billing Cycle is not pre- Monthly with ability to increase frequency
defined. Please clarify if it is a at a later date.
single or Multiple Billing Cycles
per month?
109. b.9.5.13 When premiums are received Yes.
over phone it is assumed that
the same UI /Interface will still
be used to get the details into
the system
110. b.9.5.13 Ability to receive employer Credit card.
monthly premiums … over the
phone.
How are premiums meant to
be accepted over the phone?
111. b.9.4.15 How is b.9.4.14 different from One relates to an instance of a bill, the
b.9.4.15? other to the complete account.
Response to Vendor Questions on HIP Automaton Project RFP 15 of 27
Page Section
Q# Question / Clarification Answer
# #
112. b.9.5.18 What is the logic use in the The requirement is to be able to receive
anti- selection process? the MRF premiums from other insurers
and/or approve schemes. Anti-selection
logic is not required to satisfy this
requirement. This mechanism of
collecting premiums is also a legal
requirement for DOSI.
113. b.9.5.19 When the frequency of Yes.
premium billing is modified,
some of the functionalities
could be impacted. Is it a fair
assumption to say that any
changes in Billing frequency
will be applicable only from the
subsequent billing process?
114. b.9.4.19 Are there national occupation No.
codes? Or do we need to track
by use of pseudo codes?
115. b.10.1.7 Ability to generate vendor The new provider is first encountered by
number based on sequencing the receipt of a claim in the HIP system.
when a new provider is
encountered for payment.
As all payments are routed via
JDE and must be set up in JDE
to receive payment, will the
JDE system not be the one
that will generate the vendor
number?
116. b.10.2.1 Integrate is a large work in this The specific type of information to be
context. What information shared has not been defined yet. This is a
would you like to share? How? general requirement with many possible
To what systems? examples depending on the scenario: a)
in the claims area, this is electronic
receipt of claims from insurers; b) in the
re-licensing area, this is electronic receipt
of annual statistics, standard policy
wording and applications; c) in the
policyholder area, this might be verifying
a member is insured with the insurer.
117. b.10.2.3 Is unique Provider No.
Identification already
implemented?
118. b.10.2.6 What are the details of the Must be in good standing – e.g. submit
criteria for preferred providers? claims in time.
Are there any in or out of
network providers and if so No, don't have a network.
what are the criteria?
Response to Vendor Questions on HIP Automaton Project RFP 16 of 27
Page Section
Q# Question / Clarification Answer
# #
119. b.10.2.7 Ability to provide different Faster payment.
levels of service based on
preferred status.
What is meant by this in
relation to providers? Could an
example be provided?
120. b.10.2.8 Delinquent in sending claims Yes.
later than desired?
121. b.10.2.8 Delinquent of what? Late submission of claims.
Credentials? Claims timely
filing submissions?
122. b.10.2.10 Please explain what a typical E.g. ability to pay with cheque.
process might be.
123. b.10.2.12 Circulars, is this marketing The requirement is to send
material correspondence to any provider regarding
DOSI operations. Examples include, but
are not limited to: updates on DOSI
implementing its automated system,
marketing material, notification of office
closures for public holidays, notifications
of rate changes, annual legislation
updates, any changes to the HIP Plan,
etc.
124. b.10.2.16 The claims system needs to The requirement is to enable HIP to
receive data and be able to capture: a) which physicians are
report upon that data. What submitting claims; and b) which members
are you trying to achieve here must pay and seek reimbursement from
DOSI directly because the physician billed
that member directly and by-passed
submitting the claim to DOSI. It is the
desire within Bermuda for physicians to
only charge the patient for the amount of
the service that exceeds the insurers‟
expected payment to the physician.
125. b.10.3.5 What is the criteria for a late The criteria should be flexible i.e. user
claim? defined.
126. b.10.3.6 What criteria should be Accuracy, duplicate claims (potential
monitored by provider? fraud),timeliness, etc.
127. b.10 b.10.4.1 For electronic payments are we All payments are handled through JDE
looking at using a third party and existing or planned ancillary
Off –the shelf product for this? applications.
128. b.10.4.1 Can receive input file for No answer is applicable.
checks issued/cleared.
129. b.10.4.2 Currently supports users in No answer is applicable.
defining a "pay file" in
whatever format the recipient
desires.
130. b.10 b.10.4.3 For electronic re-imbursements See question 127 above.
are we looking at using a third
party Off –the shelf product for
this?
Response to Vendor Questions on HIP Automaton Project RFP 17 of 27
Page Section
Q# Question / Clarification Answer
# #
131. b.10 b.10.3.4 For receiving paper claims, are Up to vendor to suggest the effective
we looking at scanning the approach.
paper claims using OMR or
OCR.
132. b.10 b.10.3.2 For bulk loading claims, are we Yes.
looking at any standardized
formats such as HIPAA
133. b.10 b.10.3.3 Need more information about Will be provided at a later date.
the standard HIP format
134. b.10.6 Would the system have to Yes. This is envisioned as a “messaging”
interface with insurers for interface between the Government and
applications, licence and other the insurers. The insurers and schemes
purposes? Is there a list of are variable.
identified insurers and
approved schemes?
135. b.10.6.1 Where do these funds get Not related to claims. Placed in a special
applied in the claims system? account.
Is it funding for various
accounts?
136. b.10.6.2 What licenses and for what Health Insurance companies in Bermuda
approved schemes? Data are licensed by the Government.
coming from what source? Individual employers large enough to
How? Could be a document have their own „approved scheme‟ for
management solution. health insurance are also licensed by the
Bermuda Government to conduct health
insurance business. Data is in the form
of Excel spreadsheets and Word
documents.
137. b.10.6.2 If licensing applications are Licensing applications should be received
scanned and indexed, and electronically as formatted data not
delivered electronically, our images.
application integrates with
imaging systems to
automatically import and route
such documents.
138. b.10.6.2 Ability to receive licensing Licensing applications and schemas
applications electronically from should be received electronically as
insurers and approved formatted data.
schemes. HIGH
What is meant by this? An
application could be received
by email, or posted to an ftp
site or is this referring to
uploading applications based
on an EDI format? Do the
insurers generally have the
facility to provide applications
in EDI formats? Are there that
many new insurers/approved
schemes a year in Bermuda to
warrant this?
Response to Vendor Questions on HIP Automaton Project RFP 18 of 27
Page Section
Q# Question / Clarification Answer
# #
139. b.10.6.3 What will need to be stored, Applications and schemes are submitted
images? PDF's? as formatted data.
140. b.10.6.3 Ability to receive the financial Financial statements and additional
statements and additional documentation should be received
documentation electronically. electronically as formatted data.
HIGH
As above these could be
received by email, or posted to
an ftp site or is this referring to
uploading based on an EDI
format? Do the insurers
generally have the facility to
provide these documents in
EDI formats?
141. b.10 b.10.6.4 Does this involved creating a No, should be an internal automated
customized report fro annual process.
re-licensing
142. b.10.6.5 Please clarify Requires the ability to produce a pre-
loaded, standard document / certificate
called a „license‟ and possibly print these
licenses.
143. b.10.6.6 Please clarify Ability for the system to automatically
send the electronic document (license) to
a specified person in the Ministry of
Health (authorizing the approval of
licenses to the insurance companies).
Claims ( c )
144. c.1.2.2 Please provide a definition of Metrics such as how current the
the parameters that should be administration of contractual changes
monitored. are, how many duplicate claims are
received, etc are required to produce
these.
145. c.1.1.4 Has DOSI defined specific data The intent is to physically share
and interfaces for sharing aggregate information, not electronically
information/it uses standard exchange detailed data.
HIPAA transactions for the
same? Please share any
additional details with us to
help us estimate the effort
involved in terms of number of
data elements/attributes and
number of interfaces
146. c.1.1.5 Are we looking at “context The context here is the adjudication
sensitive help” only for Claims process and the best way to adjudicate a
module or do we need it for claim that is not automatically processed.
the other modules as well?
Please confirm?
Response to Vendor Questions on HIP Automaton Project RFP 19 of 27
Page Section
Q# Question / Clarification Answer
# #
147. c.1.2 Would there be a disease Yes.
management aspect to the
system - as a sequel to
tracking chronic
diseases/hospitalizations/major
procedures, etc?
148. c.2.1 Will the treatment histories be Treatment history will be a combination.
recorded via the claim based
patient health records (PBHR)
into the system/or a
combination of PBHR and
consumer inputs of their own
health records?
149. c.2.8 Please define focus. Focus is on the “patient” (all claims /
treatments) not an individual claim.
150. c.1.3.6 On an average, it turns out to Refer to the response to question 11.
be 250 claims per day. How
many claims are currently
being handled per person/per
day at HCS Bermuda?
151. c.3.1 What kind of Audit we're The system should randomly select a
looking at here? Is it like, we claim for audit, that is verification that
generate a report and analyze the treatment actually took place - the
it offline? system could also generate a report of
randomly selected claims. We may audit
claims to ensure that the eligibility rules
are correct.
152. c.3.2 - Are these all Reporting There may be additional reports required
c.3.7 requirements? Please clarify? once the solution is better understood.
153. c.3.10 Please define or forward a The claims service standards under
copy of your claim service development and variable.
standards.
154. c.6.1.1 How would the claims get That would be part of the new
received through website? Do application.
we have claims data entry
through internet?
155. c.6.1.1 Claims received through Faxes Correct, after which the adjudication and
and Paper based claims would payment process is common for all
get entered into the system channels.
through the front end? Please
confirm the same?
156. c.6.1.4 How we would be able to Claims originating from other insurers are
validate this in case if it turns processed by them, so this is not a
out to be a paper based claim? possible situation, and other insurers are
“trusted”.
157. c.6.2.3 “Minimum claim requirements” Yes, requirements such as eligibility, and
do we mean the different claimant registered in system.
validations that needs to be
done before it gets into the
system? Please confirm?
Response to Vendor Questions on HIP Automaton Project RFP 20 of 27
Page Section
Q# Question / Clarification Answer
# #
158. c.6.2.3 By 'Accepted' we mean the Yes.
claim gets into the system
successfully. Please validate?
159. c.6.2.4 Are we looking at the proofs Proofs could be sent electronically, or
being sent electronically? Or could be paper based, which would mean
someone would update the scanning. This would be followed by an
statuses in the application update of the claim.
manually?
160. c.6.2.4 Are you requesting Yes, for paper based proof.
scanning/imaging services?
161. c.6.2.5 Depending upon the member Yes.
to whom this claim is raised, it
would get look up the
corresponding policy and
product (to which the member
is associated with?). Please
confirm the same?
162. c.6.2.7 What is a "Claim Processor" in The person performing manual
this context? How many adjudication.
different types of claims The number is currently under review.
processors are there?
163. c.6.2.7 Define business rules An example of a business rule would be
“If claim amount is over $1,000, a senior
claim processor is required to adjudicate”.
164. c.7.1.3 “Ability to determine claim Depending on the type of claim ensure
requirements” – we mean that all pertinent information has been
validating the claims entered received.
manually/electronically
received for completeness? Is
our understanding
appropriate?
165. c.7.1.3 Beyond eligibility confirmation? Yes, depending on the type of claim
Such that a specific benefit ensure that all pertinent information has
would require additional been received.
documents?
166. c.7.1.4 “Ability to simplify / automate” Business rules should be externalised.
– do we mean Business users should be able to update
“parameterization” of the the rules based policy / product
validation rules? Please information, or alternatively the
confirm? If so, under what all application handling policy / product
scenarios the validation rules administration could generate them.
might potentially change?
167. c.7.1.5 Are we looking at sending Yes.
automated notifications to the
concerned stakeholders during
adjudication process
requesting the additional
information for processing?
Please confirm?
Response to Vendor Questions on HIP Automaton Project RFP 21 of 27
Page Section
Q# Question / Clarification Answer
# #
168. c.7.1.10 From where the “Eligibility List” The eligibility will lists will evolve in for
is received? What is the most products. Some lists will be
frequency of the upload received periodically to update the
process? eligibility lists.
169. b.7.1.19 Ability to receive requirements Whatever is the most efficient solution.
electronically (such as letter
from physician). HIGH
As above, is this referring to
email or uploading into the
system?
170. c.7.2.2 What kinds of printing/mailing Forms and letters to administer the
of pre-defined forms and products such as lapse letters, residency
letters are considered here? letters, EOB‟s, follow-up letters, etc.
171. c.7.3.1 Is it an automated process? No.
Please confirm?
172. c.7.3.5 What is the business The claim would not be eligible.
significance of determining
whether the claim is >13
months old?
173. c.7.4.2 Why do we need to record Need to know whether the claim was
decision on benefits? (Claims approved, declined and why, or pended
just look up the benefit details and why.
and get adjudicated
appropriately?) Please clarify?
174. c.7.4.5 Please clarify benefit offer The reimbursement amount may not be
full the full amount of the claim and
therefore an offer is made.
175. c.7.4.9 Please clarify The claimant may come back with an
counter offer, HIP would need to decide
whether or not to accept the counter
offer and if they do record this detail.
176. c.7.4.15 for all claims submitted on a Up to the provider. Long term vision is to
certain day? By what criteria have claims submitted as individual
will claims be batched? transactions (messages).
177. c.7.5.1 Are we looking at a generic This is basically the ability to switch to
Medical Dictionary/Directory of another browser window with a
Physicians or something predefined url (could be a medical
specific to that geography? Dictionary).
Where are these
directories/dictionaries
available?
Response to Vendor Questions on HIP Automaton Project RFP 22 of 27
Page Section
Q# Question / Clarification Answer
# #
178. b.7.5.1 Ability to link with claims See above.
resource material for the user
to search the internet for
Medical Dictionary, directory of
physicians. HIGH
Do the Department of Social
Insurance users not already
have access to the internet? A
link could be provided within
the application but most users
already have a desktop and
favourites for managing this.
179. c.7.5.2 “Provide Online access to Yes. This information could be on the
resource materials, manuals, internet or intranet.
and protocols” – means
providing quick links to
frequently accessed
information? Is our assumption
appropriate?
180. c.7.5.4 Is this to be a provider search Yes.
based on criteria like specialty,
location, accreditation, and
other quality data?
181. c.7.5.5 Is this an online service to be Should be available for both DOSI staff,
created for the policyholders? policy holders, and residents.
182. c.7.5.5 Please clarify how this would Yes it would be independent of the
work. It seems this would be specific application, but would be part of
independent of the system an overall end-to-end solution.
183. C.7.5.5 Ability to search for all An example could be providers of
government and free physiotherapy.
resources and counseling that
policyholders may not be
aware of. What
does this mean - can we get
an example of this scenario
184. c.8.1.1 Is this the same as Explanation Yes.
of Benefits (EOB) that is sent
to the claimant? Please clarify?
185. c.8.2.1 Please clarify View it as special process indicator. In
this case it is recovering the funds from
an auto insurer.
186. c.10.1 related to duplicate billing? Some other criteria: Treatment never
related to billing for non- took place (either provider or consumer) ,
eligible members? What other faked receipts, and faked accidents, etc.
criteria are included for
determination of fraud?
187. c.10.3 How is a fraudulent claim Procedures need to be developed.
settled?
Response to Vendor Questions on HIP Automaton Project RFP 23 of 27
Page Section
Q# Question / Clarification Answer
# #
188. C.10.5 ability to forward case to Since this is fraud this is needed to take
inspectors and or legal support legal or other action.
to manage. What does this
mean and can you provide an
example
Financial & Risk
Management (d)
189. d.3.1 What level of automation and The specific requirements are elaborated
what are the specific financial in d4 – d7.
processes that we are looking
at
190. d.3.1 which processes, specifically? As above.
191. d.3.2 How many such interfacing Currently JDE is the only financial
applications are we looking at application HIP needs to interface with.
192. d.3.3 We were under the impression Correct assumption.
that you would be keeping JE
Edwards accounting package,
of which our application would
have to integrate with. If this
is not the case, please clarify.
193. d.3.4 We were under the impression Correct assumption.
that you would be keeping JE
Edwards accounting package,
of which our application would
have to integrate with. If this
is not the case, please clarify.
194. d.3.5 We were under the impression Correct Assumption.
that you would be keeping JE
Edwards accounting package,
of which our application would
have to integrate with. If this
is not the case, please clarify.
195. d.3.5 --for claims payment For HIP.
processes? For DOSI? Please
provide more detail for the
budgets to be managed
196. d.3.5 Are we looking to do this via This would be a normal annual budget,
periodic comparison reports or and the ability to see how HIP track to it.
otherwise
197. d.3.6 We were under the impression Correct assumption.
that you would be keeping JE
Edwards accounting package,
of which our application would
have to integrate with. If this
is not the case, please clarify.
Response to Vendor Questions on HIP Automaton Project RFP 24 of 27
Page Section
Q# Question / Clarification Answer
# #
198. d.4.1 How should the system Require the ability to record the
evaluate underwriting underwriting guidelines and with the
guidelines, would it have to claim metrics and product performance
compare the underwriting metrics will be able to do the required
procedures for a specific analysis.
policy, plan against the base
rules set up already
199. d.4.8 This may refer to Incurred but yes it is similar but in this case it is not a
not received, Please clarify. known claim.
200. d.5.1 What information would be This would be access to the applications
required for remote access? Or and information through VPN connections
are we looking at hosting the from outside the government network.
application on the internet to
support remote accessibility
201. d.6.1 – Please advise the status of JD JDE is the government‟s financial
d.6.18 Ewards package.
202. d.6.4 record in what way? Separate For a particular product, require the
from opening an account? ability to record the correct account that
the claim should be debited against.
203. d.6.7 please provide more detail This will be based on business rules as to
whether the system can authorize the
payment or an individual is required to
authorize.
204. d.6.11 what details would be the To be determined at the time of
focus of the evaluation? evaluation.
205. d.7.12 – Is this a function of the JD Some are, some are not. Any decisions
d.7.22 Ewards software, or does this should be done within the HIP system.
need to be qualified with
Microsoft Dynamics Accounting
software
206. d.7.15 apply a refund payment to a This is a normal payment.
claim?
207. d.7.25 – Is this a function of the JD Some are, some are not. Any decisions
d.7.28 Ewards software, or does this should be done within the HIP system.
need to be qualified with
Microsoft Dynamics Accounting
software
208. d.7.20 for any other payments than Yes.
claim payments?
209. d.7.22 please provide more detail The requirement is to be able define the
process for payments.
210. d.7.30 – Is this a function of the JD Some are, some are not. Any decisions
d.7.32 Ewards software, or does this should be done within the HIP system.
need to be qualified with
Microsoft Dynamics Accounting
software
211. d.7.30 what investments are referred In error, not a requirement.
to here?
212. d.8 How many reports in total in This will be decided during the next
envisions at present phase of the Automation project.
Response to Vendor Questions on HIP Automaton Project RFP 25 of 27
Page Section
Q# Question / Clarification Answer
# #
213. d.8.1.2 Are we missing something This is an oversight. Please ignore this
here? requirement.
214. d.8.1.14 In what way this is different Are we really talking meta data here???
from d.8.1.8.Can we assume (both cases).
the y both mean the same
215. d.8.1.15 What are the key indicators? These are business process performance
Although they are referred to indicators, such as time to process a
in the non-functional claim, number of claims received,
requirements they are not approved, etc.
defined specifically
216. d.8.1.15 Ability to define and maintain See above.
key performance indicators.
HIGH
Could you provide examples?
217. d.8.1.16 Ability to support business Forecasting items like anticipated claim
forecasting. HIGH volumes or claim payments.
Could you provide examples?
218. d.8.1.17 How many such interfaces are Will be determined during design.
we talking about and do the
interfaces need to be custom
built for each f the interfacing
source systems
219. d.8.2 Sample reports – Reports The information contained in the report is
to include but not inclusive. not necessarily maintained by the HIP
HIGH system. E.g. HR related information
Unsure what “to include but would come from the HR system, and
not inclusive” means. If this asset related information would come
means all reports listed may from inventory systems.
not have to be included then
the following questions may
not be applicable. If it means
not an exhaustive list then
they are applicable.
d.8.2.7
Operational/administrative
activities (such as staff,
payroll, staffing expenses such
as pensions, tax, efficiency
ratios)
If reporting on these details
the system must capture them.
Is the new system meant to
track all of this information?
d.8.2.8 Facilities, maintenance,
assets (such as building,
vehicles, IT, hardware
as above, is the new system
meant to track all of this?
220. d.8.2.8 Is this report relevant here This is part of the overall cost picture for
HIP.
Response to Vendor Questions on HIP Automaton Project RFP 26 of 27
Page Section
Q# Question / Clarification Answer
# #
Access, Security & Privacy
Management (e)
221. e.10.2.26 Please provide more detail on This requirement refers to being able to
the contents of this worksheet. make notes on the claim regarding
decisions being made such that other
users can pick the claim up and easily
understand where the claim is in the
process.
222. e.10.2.45 Ability to personalize the Yes.
elements on the interface
according to personal
preferences?
Application Function Model
223. Would you please provide .jpg files are available on the RFP web
separate images (.jpg, .tif or site.
.bmp will do, or native
document format) of Figures 5
(page labelled 55 of 78) and 6
(page labelled 56 of 78) from
the Application Function Model,
since they appear cut-off on
the right hand side in the PDF
formatted RFP template.
Conceptual Nodes
224. Table 4 “Conceptual Nodes” Table 4 is part of the RFP PDF file – try
did not appear in our downloading again.
document. Please provide.
225. 12.4 Conceptual Nodes states “Most The following nodes exists in some form:
of the Nodes required to Application Node, Authentication Node,
support the HIP applications Backup Node, Call Centre Node,
and data already exist in the Collaboration Node, Data Warehouse,
Government‟s IT Database Node, Directory Node, Fax, File
environment”. Server, Firewall, Informational Node,
Could you please confirm Internet Client, Intranet Client, Load
which Nodes of the ones listed Balancing Node, Mail Node, Malicious
already exist and which ones Threat Detection, Portal Node, Proxy,
do not exist for the HIP Reverse Proxy, Security Management
project? Node, Systems Management Node,
Scanner, VPN Client, Web Application
Node.
Response to Vendor Questions on HIP Automaton Project RFP 27 of 27